MEDICARE: DR. CRISTIAN RADANEATA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WL0500X	Low Vision Rehabilitation Optometrist	5189TG	TX
2	152WP0200X	Pediatric Optometrist	5189TG	TX
3	152WC0802X	Corneal and Contact Management Optometrist	5189TG	TX
4	152W00000X	Optometrist	5189TG	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01042734	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992702864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTIAN RADANEATA OD

Provider Business Mailing Address
First Line	:	1016 S 14TH ST
Second Line	:
City	:	KINGSVILLE
State	:	TX
Zip	:	78363-6422
Country	:	US
Telephone Number	:	361-592-4744
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 S 14TH ST
Second Line	:
City	:	KINGSVILLE
State	:	TX
Zip	:	78363-6422
Country	:	US
Telephone Number	:	361-592-4744
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	06/12/2024

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